Male and female hair loss: Tailored treatment approaches

Epidemiology and Patterns of Hair Loss

Androgenetic alopecia (AGA) is the most prevalent form of hair loss in both sexes. In men, AGA, commonly known as male pattern baldness, typically manifests as a receding hairline and thinning at the vertex, potentially progressing to complete baldness. Conversely, female pattern hair loss (FPHL) often presents as diffuse thinning over the crown with preservation of the frontal hairline. Epidemiological studies indicate that approximately 50% of men and women experience some degree of AGA by the age of 50. However, the psychosocial impact may be more profound in women, given societal standards and expectations regarding female appearance.

Pathophysiology

The pathogenesis of AGA involves a combination of genetic predisposition and hormonal influences. Dihydrotestosterone (DHT), a potent androgen derived from testosterone via the enzyme 5-alpha reductase, plays a central role in follicular miniaturisation in genetically susceptible individuals. This process leads to the transformation of terminal hairs into vellus hairs, resulting in visible thinning. While the mechanism is similar in both genders, the extent and pattern of hair loss differ, possibly due to variations in androgen levels, receptor sensitivity, and other hormonal factors.

Diagnostic Considerations

A thorough clinical evaluation is essential to distinguish AGA from other causes of hair loss, such as telogen effluvium, alopecia areata, or scarring alopecias. In addition to a detailed medical history and physical examination, dermoscopic assessment can aid in identifying characteristic features of AGA, such as variability in hair shaft diameter and perifollicular pigmentation. In women, evaluating for signs of hyperandrogenism, including hirsutism and menstrual irregularities, is important, as these may suggest underlying endocrine disorders like polycystic ovary syndrome (PCOS). Laboratory investigations may include assessments of serum androgens, thyroid function tests, and iron studies, particularly when clinical suspicion arises for alternative or concurrent causes of hair loss.

Treatment Modalities

Management of AGA aims to halt progression and stimulate regrowth, employing both pharmacological and non-pharmacological strategies.

Pharmacological Treatments

Topical Minoxidil: Minoxidil is a non-prescription topical agent approved for the treatment of AGA in both men and women. Its mechanism involves prolonging the anagen phase and enlarging miniaturised follicles. Clinical trials have demonstrated its efficacy in promoting hair regrowth, with a response rate of approximately 40-60%. Adherence to treatment is crucial, as discontinuation can lead to relapse.
Oral Finasteride: Finasteride, a 5-alpha reductase inhibitor, reduces the conversion of testosterone to DHT. It is approved for use in men with AGA and has been shown to increase hair count and improve hair density. However, its use in women is controversial due to potential teratogenic effects and limited evidence of efficacy. A systematic review highlighted that while finasteride is effective in men, more research is needed to establish its role in female patients.
Anti-Androgens: For women with FPHL, particularly those with signs of hyperandrogenism, anti-androgens such as spironolactone and cyproterone acetate may be considered. These agents antagonise androgen receptors, potentially mitigating hair loss progression. A study reported that these treatments appear to work best when initiated early in the course of hair loss.

Non-Pharmacological Treatments

Low-Level Laser Therapy (LLLT): LLLT involves the use of red light lasers to stimulate hair growth. Meta-analyses have suggested that LLLT can be beneficial for both men and women with AGA, although the quality of evidence varies. Consistency and duration of treatment are key factors influencing outcomes.
Platelet-Rich Plasma (PRP): PRP therapy entails injecting concentrated platelets from the patient's own blood into the scalp to promote hair regrowth. Studies have shown variable efficacy, and while some patients experience significant improvement, others may see minimal benefits. The procedure is generally well-tolerated, with minimal adverse effects.
Hair Transplantation: Surgical intervention may be considered for patients with significant hair loss unresponsive to medical therapies. Techniques such as Follicular Unit Extraction (FUE) and Follicular Unit Transplantation (FUT) involve harvesting hair follicles from donor sites and implanting them into balding areas. Outcomes are largely dependent on surgeon expertise and patient-specific factors.

Associated Costs

The financial implications of hair loss treatments in the UK vary widely based on the chosen modality:

Hair Transplantation: Surgical hair restoration is a significant financial investment, with a quick search for how much does a hair transplant cost in uk on google giving results from £2,500 up to £8,000 dependent on the clinic and location.

Topical and Oral Medications: Over-the-counter minoxidil products are available at relatively low cost, with monthly expenses averaging between £20 to £30. Prescription medications like finasteride may incur higher costs, depending on the prescribing physician and pharmacy pricing.
LLLT Devices: Home-use LLLT devices, such as laser combs or helmets, can range from £200 to £600. Professional in-clinic treatments may be more expensive, with session costs varying by provider.
PRP Therapy: The cost of PRP therapy in the UK typically ranges between £200 to £600 per session, with multiple sessions often required to achieve desired results. At some clinics, one session is priced at £300.

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